A country of 36 million, Uganda has the second highest fertility rate in the world. Despite progress over the last decade, maternal mortality remains high. Limited access to quality maternal care continues to put Ugandan women at risk of pregnancy-related disability as well. Obstetric fistula, a vaginal injury usually caused from prolonged labor without timely medical attention, is common, and many women are unaware that it can be treated and often repaired.
Since 2004, the Fistula Care project has worked with Ugandan health centers and hospitals to build awareness of obstetric fistula and support its prevention, treatment, and repair. Under the previous Fistula Care project from 2004 to 2013, we trained 26 doctors and 761 nurses to perform fistula repair surgery, and supported a total of 3,534 surgeries. We also greatly improved the quality of obstetric care and family planning services, both of which enable fistula prevention and worked with the ministry to help create “Learn From My Story,” a DVD of women with fistula sharing their stories. This collection is used in a variety of ways to raise awareness about the problem of fistula, both locally and worldwide.
Our work today continues to focus on strengthening fistula prevention and treatment in Uganda through the Fistula Care Plus project. We are expanding efforts to build community awareness, increasing our emphasis on the integration of family planning services with fistula and maternal health care, and addressing the enormous backlog of women awaiting life-altering fistula repair.
In addition to seven prevention-only sites, Fistula Care Plus has been working with two private, faith-based hospitals to prevent and repair fistula:
Hoima Hospital is a regional referral hospital in western Uganda approximately 140 miles west of Kampala. The 280 bed public hospital offers a wide variety of services including a 29 bed maternity ward and an obstetric operating theater where fistula repair occurs. Hoima Hospital opened in as a district hospital in 1930, but since 1994 the hospital has served as a regional referral hospital serving 5 districts of Hoima, Buliisa, Kibaale, Kiryandongo and Masindi with a population of approximately 2 million people. Hoima Hospital conducts fistula repair outreach, holds concentrated repair sessions, provides family planning services to fistula patients, and conducts refresher training courses. With support from Fistula Care, the health facility pioneered the implementation of the mentoring and coaching strategy for fistula surgeons in Uganda.
Kitovu Mission Hospital is located 120 km southwest of Kampala in Masaka District, on the shores of Lake Victoria. The 200-bed hospital has a special fistula repair clinic, which serves as a referral site for complex fistula repairs. Visiting master surgeons regularly hold camps at Kitovu Hospital at which many women with fistula can be repaired at once. This provides an important opportunity to train both new and existing fistula surgeons, along with surgical teams. Fistula Care is helping Masaka District Hospital, a 240-bed public hospital nearby, to refer patients with fistula to Kitovu Hospital and to strengthen its emergency obstetric care to prevent new fistulas from occurring.
Kagando Mission Hospital is located in Kasese District in southwestern Uganda, along the Congolese border. It opened in 1965 as a hospital primarily for lepers operated by the Africa Inland Mission. Over time, the Kagando Hospital diversified greatly, and today it offers 200 beds and services ranging from maternity to surgery to health education. The hospital is part of a rural development initiative that focuses on prevention, invites voluntary service, and encourages the community to be part of the decision-making process. Fistula Care is working with Bwera District Hospital, a public hospital with 120 beds, to refer fistula patients to Kagando Hospital and to improve its emergency obstetric services.